Connect with us

National

What’s next for health care reform?

After court ruling, focus turns to state plans for Medicaid

Published

on

Now that the Supreme Court has upheld the constitutionality of President Obama’s health care reform law, advocates are pushing for additional efforts to extend coverage of the law to LGBT people and people with HIV/AIDS to the fullest extent possible.

For the most part, the next step in the process involves looking to the states to determine whether they will adopt health policies afforded to them under the law ā€” foremost among them is the Medicaid expansion to cover all people with incomes up to 133 percent of the federal poverty level.

Although the Supreme Court ruled the majority of the health care law is constitutional, it prevented the federal government from withholding all Medicaid funds from states if they decline to take part in the Medicaid expansion. As a result, states can decide whether or not to enter the expansion without fear of losing money.

Patrick Paschall, a policy advocate at the National Gay & Lesbian Task Force, said the Medicaid expansion is particularly important for LGBT people because they disproportionately live below the poverty level.

“The Medicaid expansions are going to end up being hugely important for LGBT people because it expands coverage to low-income people, and LGBT people are disproportionately low-income,” Paschall said. “We know this because of rampant employment discrimination and housing discrimination.”

A report on transgender people published earlier this year by the Task Force and the National Center for Transgender Equality, titled “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” found that transgender people experience unemployment at rates twice that of the national population, and black transgender people experience it at a rate of four times as much.

Carl Schmid, deputy executive director of the AIDS Institute, said the Medicaid expansion is particularly important for people with HIV/AIDS because of 50 percent of those in care rely on that program for support and those numbers will “grow substantially” if states decide to participate.

“Those who are really poor, they’re going to be covered under Medicaid,” Schmid said. “The question is what are we expecting from the states.”

But a number of states may not take part. According to a report in The Hill newspaper, at least 15 governors have signaled they won’t participate in the Medicaid expansion now that the Supreme Court has enabled them to wiggle out of participation.

Florida Gov. Rick Scott, a Republican elected to office during the Tea Party wave in 2010, was among those saying his state wouldn’t take part in the Medicaid expansion ā€” or other parts of the health care law that are optional to the states.

“We’re not going to implement Obamacare in Florida,” Scott said last week on Fox News. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”

Under the health care reform law, the federal government will pay for the Medicaid expansion for the first few years. Expenses for states come up in 2017, when the federal government will pay 95 percent; That’s reduced to 94 percent in 2018 and in 2019 it goes down to 93 percent. Starting in 2010 and then on out, the federal government will pay 90 percent of the total amount.

Schmid said the bargain that was set up for states under the health care law makes the governors’ decision not to participate in the law questionable.

“Here their taxpayers are going to be paying their taxes to pay for this; this is federal funds,” Schmid said. “Their state is not going to take responsibility for covering. The hospitals? Don’t they want people to be covered? They’re going to have unconstituted care if they don’t.”

For the states that don’t participate in the Medicaid expansion, Schmid said people living there with HIV/AIDS will have to continue relying on the Ryan White Care Program, which provides funds for AIDS medications for low-income people with HIV. The program will be up for reauthorization in 2013.

As advocates push for states to adopt the Medicaid expansion, the law has several key components that already offer protections and benefits for LGBT people and people with HIV/AIDS. State and federal health insurance will be set up in the law starting in 2014.

For the first time, the law extends federal non-discrimination protection in the health care system on the basis of gender.

Paschall noted that provision is key as courts and agencies have determined that discrimination against transgender people amounts to gender discrimination.

“We know that federal agencies like the Equal Employment Opportunity Commission, the Department of Housing & Urban Development as well as federal courts have interpreted sex-based discrimination to include protections on the basis of gender identity and sex stereotypes,” PaschallĀ said. “What this means is that in the context of health care, LGBT people, especially transgender people have now for the first time protections in that setting, which is hugely important.”

Earlier this year, the Department of Health & Human Services issued rules saying that no program activity in an exchange, nor a health plan, can discriminate on the basis of sexual orientation and gender identity. The rule takes effect when exchanges open in 2014.

The administration has taken additional efforts to help the LGBT community when it comes to accessing health care.Ā Same-sex couples can now search for health plans that cover domestic partners through the health care finder tool at healthfinder.gov. HHS has also undertaken data collection efforts to include questions about sexual orientation and gender identity in surveys like theĀ National Health Interview Survey.

Still, advocates are looking for additional efforts from the administration ā€” in addition to the adoption of the Medicaid expansion by the states ā€” to ensure LGBT people are included in health care reform to the greatest extent possible.

Paschall said the Task Force wants to see data collection efforts expanded beyond the federal surveys already designated by the administration.

“Generally speaking, we would like to see sexual orientation and gender identity questions added to all federal surveys where demographic data is collected,” he said. “Our priorities include a number of federal surveys, maybe most notably the American Community Survey, which is an annual survey that collects demographic data and is considered one of the largest annual data sources on the American population.”

Paschall continued, “We’re also working with them to ensure that those questions are developed and included in other federal health surveys across the board so that we can have more data in more areas identify where those disparities are.”

For people living with HIV/AIDS, Schmid said he is awaiting from the administrationĀ regulatory guidance in the next couple months on essential health benefits to cover people in the Medicaid program and federal exchanges.

“We’ll see if the coverage will be strong enough for medications and for all different other services,” Schmid said.

Advertisement
FUND LGBTQ JOURNALISM
SIGN UP FOR E-BLAST

State Department

Transgender, nonbinary people file lawsuit against passport executive order

State Department banned from issuing passports with ‘X’ gender markers

Published

on

(Bigstock photo)

Seven transgender and nonbinary people on Feb. 7 filed a federal lawsuit against President Donald Trump’s executive order that bans the State Department from issuing passports with “X” gender markers.

Ashton Orr, Zaya Perysian, Sawyer Soe, Chastain Anderson, Drew Hall, Bella Boe, and Reid Solomon-Lane are the plaintiffs in the class action lawsuit the American Civil Liberties Union, the ACLU of Massachusetts, and the private law firm Covington & Burling LPP filed in U.S. District Court for the District of Massachusetts. The lawsuit names Trump and Secretary of State Marco Rubio as defendants.

Former Secretary of State Antony Blinken in June 2021 announced the State Department would begin to issue gender-neutral passports and documents for American citizens who were born overseas.

Dana Zzyym, an intersex U.S. Navy veteran who identifies as nonbinary, in 2015 filed a federal lawsuit against the State Department after it denied their application for a passport with an ā€œXā€ gender marker. Zzyym in October 2021 received the first gender-neutral American passport.

The State Department policy took effect on April 11, 2022.

Trump signed the executive order that overturned it shortly after he took office on Jan. 20. Rubio later directed State Department personnel to ā€œsuspend any application requesting an ā€˜Xā€™ sex marker and do not take any further action pending additional guidance from the department.ā€  

ā€œThis guidance applies to all applications currently in progress and any future applications,” reads Rubio’s memo. “Guidance on existing passports containing an ā€˜Xā€™ sex marker will come via other channels.ā€

The lawsuit says Trump’s executive order is an “abrupt, discriminatory, and dangerous reversal of settled United States passport policy.” It also concludes the new policy is “unlawful and unconstitutional.”

“It discriminates against individuals based on their sex and, as to some, their transgender status,” reads the lawsuit. “It is motivated by impermissible animus. It cannot be justified under any level of judicial scrutiny, and it wrongly seeks to erase the reality that transgender, intersex, and nonbinary people exist today as they always have.”

Solomon-Lane, who lives in North Adams, Mass., with his spouse and their three children, in an ACLU press release says he has “lived virtually my entire adult life as a man” and “everyone in my personal and professional life knows me as a man, and any stranger on the street who encountered me would view me as a man.”

ā€œI thought that 18 years after transitioning, I would be able to live my life in safety and ease,” he said. “Now, as a married father of three, Trumpā€™s executive order and the ensuing passport policy have threatened that life of safety and ease.”

“If my passport were to reflect a sex designation that is inconsistent with who I am, I would be forcibly outed every time I used my passport for travel or identification, causing potential risk to my safety and my familyā€™s safety,ā€ added Solomon-Lane.

Continue Reading

Federal Government

Education Department moves to end support for trans students

Mental health services among programs that are in jeopardy

Published

on

The U.S. Department of Education headquarters in D.C. (Photo courtesy of the GSA/Education Department)

An email sent to employees at the U.S. Department of Education on Friday explains that “programs, contracts, policies, outward-facing media, regulations, and internal practices” will be reviewed and cut in cases where they ā€œfail to affirm the reality of biological sex.ā€

The move, which is of a piece with President Donald Trump’s executive orders restricting transgender rights, jeopardizes the future of initiatives at the agency like mental health services and support for students experiencing homelessness.

Along with external-facing work at the agency, the directive targets employee programs such as those administered by LGBTQ resource groups, in keeping with the Trump-Vance administration’s rollback of diversity, equity, and inclusion within the federal government.

In recent weeks, federal agencies had begun changing their documents, policies, and websites for purposes of compliance with the new administration’s first executive action targeting the trans community, ā€œDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.ā€

For instance, the Education Department had removed a webpage offering tips for schools to better support homeless LGBTQ youth, noted ProPublica, which broke the news of the “sweeping” changes announced in the email to DOE staff.

According to the news service, the directive further explains the administration’s position that ā€œThe deliberate subjugation of women and girls by means of gender ideology ā€” whether in intimate spaces, weaponized language, or American classrooms ā€” negated the civil rights of biological females and fostered distrust of our federal institutions.”

A U.S. Senate committee hearing will be held Thursday for Linda McMahon, Trump’s nominee for education secretary, who has been criticized by LGBTQ advocacy groups. GLAAD, for instance, notes that she helped to launch and currently chairs the board of a conservative think tank that “has campaigned against policies that support transgender rights in education.”

NBC News reported on Tuesday that Trump planned to issue an executive order this week to abolish the Education Department altogether.

While the president and his conservative allies in and outside the administration have repeatedly expressed plans to disband the agency, doing so would require approval from Congress.

Continue Reading

State Department

Protesters demand US fully restore PEPFAR funding

Activists blocked intersection outside State Department on Thursday

Published

on

HIV/AIDS activists block an intersection outside the State Department on Feb. 6, 2025. They were demanding the Trump-Vance administration to fully restore PEPFAR funding. (Photo courtesy of Housing Works)

Dozens of HIV/AIDS activists on Thursday protested outside the State Department and demanded U.S. officials fully restore President’s Emergency Plan for AIDS Relief funding.

The activists ā€” members of Housing Works, Health GAP, and the Treatment Action Group ā€” blocked an intersection for an hour. Health GAP Executive Director Asia Russell told the Washington Blade that police did not make any arrests.

Secretary of State Marco Rubio on Jan. 24 directed State Department personnel to stop nearly all U.S. foreign aid spending for 90 days in response to an executive order that President Donald Trump signed after his inauguration. Rubio later issued a waiver that allows PEPFAR and other ā€œlife-saving humanitarian assistanceā€ programs to continue to operate during the freeze.

The Blade on Wednesday reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down because of a lack of U.S. funding.

ā€œPEPFAR is a program that has saved 26 million lives and changed the trajectory of the global HIV/AIDS epidemic,” said Housing Works CEO Charles King in a press release. “The recent freeze on its funding is not just a bureaucratic decision; it is a death sentence for millions who rely on these life-saving treatments. We cannot allow decades of progress to be undone. The U.S. must immediately reaffirm its commitment to global health and human dignity by restoring PEPFAR funding.” 

ā€œWe demand Secretary Rubio immediately reverse his deadly, illegal stop-work order, which has already disrupted life-saving HIV services worldwide,” added Russell. “Any waiver process is too little, too late.”

Continue Reading
Advertisement
Advertisement

Sign Up for Weekly E-Blast

Follow Us @washblade

Advertisement

Popular